Coerced Abstinence and Substance Involved-Offenders: A New Paradigm

Next week London Deputy Mayor Kit Malthouse and I will be co-presenters at the City of London Drug and Alcohol Policy Forum. We will discuss how coerced abstinence programs could help reduce alcohol-fueled violence in the UK. Planning for the event has helped me organize my thoughts about coerced abstinence programs, which include HOPE probation, 24/7 Sobriety and Physicians Health Plans. These are my nine summary points as a cheat sheet for those of you who are interested (the embedded links may also be useful), and I particularly invite Mark to elaborate if he so chooses.

1. In terms of populations, these programs have wide applicability, having evidence of benefit with serial drink driving offenders, substance dependent physicians and airline pilots, and methamphetamine-using felony probationers. The strongest evidence is for HOPE probation, which has been studied by Angela Hawken and Mark Kleiman in a randomized trial. All the programs reduce substance use and the proximal harm that brought the person to the program, e.g., violence, impaired driving.

2. There is as yet no international comparison of these programs. It has to be said though that Hawaii (HOPE) and South Dakota (24/7 Sobriety) are pretty different places even though they are both in the U.S.

3. The substance addressed by these programs is irrelevant, as is the legal status of that substance. I suspect they will primarily be used with people who use alcohol and stimulants, but that is just a guess.

4. The prototypic person in these programs is someone who has done something harmful and criminal while intoxicated, e.g., someone who uses meth and then attempts sexual assault, an alcoholic who gets drunk and beats his wife or drives his car the wrong way on the interstate, a stoned surgical resident who leaves his non-sterilized locker key in a patient and causes a near-fatal infection. The people in these programs are thus not just “people in need”, they are also people who have done something wrong and are a public safety risk. The programs are therefore not intended solely to help them (though they do) but also to protect society.

5. The critical features of these programs are that they all use testing combined with swift, certain but modest sanctions in response to substance use. This is the inverse of the environment in which most substance-involved offenders live: Responses to use are unpredictable, delayed and frequently harsh. The former environment promotes learning whereas the latter environment impedes it.

6. These programs generally offer treatment, but entry to treatment per se is not the point: Abstinence is. As a clinician, I would be delighted to have a caseload composed entirely of people who were in a coerced abstinence program.

7. These programs all show evidence of producing a critical outcome: Keeping people out of prison. Every state with overcrowded prisons should be piloting coerced abstinence models of community supervision right now.

8. When these programs are done properly, the people in them will understand the rules and feel fairly treated. If they don’t, something is wrong.

9. The “brands” of these various programs are not the point. The UK or any other country can make up its own version to suit local needs and traditions, as long as it follows the basic principles, which are of obvious worth to anyone who has studied human learning or has had success shaping behavior (e.g., been a good parent).

Author: Keith Humphreys

Keith Humphreys is the Esther Ting Memorial Professor of Psychiatry at Stanford University and an Honorary Professor of Psychiatry at Kings College London. His research, teaching and writing have focused on addictive disorders, self-help organizations (e.g., breast cancer support groups, Alcoholics Anonymous), evaluation research methods, and public policy related to health care, mental illness, veterans, drugs, crime and correctional systems. Professor Humphreys' over 300 scholarly articles, monographs and books have been cited over thirteen thousand times by scientific colleagues. He is a regular contributor to Washington Post and has also written for the New York Times, Wall Street Journal, Washington Monthly, San Francisco Chronicle, The Guardian (UK), The Telegraph (UK), Times Higher Education (UK), Crossbow (UK) and other media outlets.

7 thoughts on “Coerced Abstinence and Substance Involved-Offenders: A New Paradigm”

  1. Al Blumstein has pointed out in a new special issue of Criminology & Public Policy that of the three traditional components of deterrence theory (certainty, celerity, and severity), the one that has been the most overlooked to date is the celerity (swiftness) component. He further goes on to point to initiatives like HOPE as nice examples of bringing a discussion of celerity to the forefront of criminological research. Mark, I thought of you this morning, as I read a verse in the Bible in church this morning which demonstrates that the wisdom of the swiftness of punishment has been with us at least since biblical times. Ecclesiastes 8:11 says "because the sentence against an evil deed is not executed speedily, the heart of the children of man is fully set to do evil." A modern paraphrased rendering of this passage (the GWT translation) reads "when a sentence against a crime isn't carried out quickly, people are encouraged to commit crimes." Can't argue with the wisdom of Solomon.

  2. Since comments are closed on the "Civility and RBC Community" posting, I will add (from one blog contributor to another) the suggestion to remove the vowels from offending posts, or parts of posts. This has come to be known as disemvoweling, and a number of blogs have found it effective. The poster does not think that the comment has tripped a spam filter or otherwise vanished into the blogoriferous aether, and readers can also see when lines are crossed. I think that several blog publishing platforms have disemvoweling tools, so it should be as easy as removing offending comments.

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